Carotid endarterectomy in Great Britain and Ireland

A survey of the practice of carotid surgery by 245 vascular and neurological surgeons in Great Britain and Ireland was conducted with a 96 per cent response. Ninety-six surgeons (41 per cent) performed at least one carotid endarterectomy in 1984 and a total of 1374 such operations were carried out in that year. The indications for carotid endarterectomy in order of frequency were transient ischaemic attack, minor stroke and stroke. Operation was hardly ever undertaken for asymptomatic carotid bruit. Eighty-six per cent of surgeons who performed carotid endarterectomy generally assessed patients in the first instance using techniques less invasive than conventional angiography, principally Doppler ultrasonography or digital subtraction angiography. Nevertheless, conventional angiograms were usually performed before surgery by 89 per cent of surgeons. Almost all surgeons operated only under general anaesthesia, while opinion on the use of an intraluminal shunt during carotid endarterectomy was divided. Despite an increase in the number of carotid endarterectomies in recent years, this operation is currently performed nineteen times less frequently in Great Britain and Ireland than in the USA. The reasons for this are explored and certain controversies surrounding carotid endarterectomy are discussed.